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Pediatrics > Acute Ilness Inclass (no panopto) > Flashcards

Acute Ilness Inclass (no panopto) Flashcards

1
Q

When should children seek medical care for dehydration?

A

-Dry mucous membranes
-crying without tears
-no UOP for 4-6 hours
-sunken eyes
-blood in stool
-abdominal pain
-vomiting for >24hrs
-fever > 103
-lethargy
-polyuria (DKA)

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2
Q

How to treat dehydration in children?

A

Oral rehydration/fluid replacement

-Pedialyte®, Rehydralyte®, Enfalyte®, CeraLyte®
contains electrolytes and some sugar (enhances water and sodium absorption)

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3
Q

What is the common dose of IV bolus for dehydration?

A

IV bolus 20 ml/kg of 0.9%, max 1000 ml
up to 30-60 min

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4
Q

Fluid doses by weight

A

<10 kg: 100 ml/kg
maintenance: 4 ml/kg/hr

11-20 kg: 1000ml + 50 ml/kg for each kg > 10
-> maintenance: 40 ml/hr + 2 ml/kg/hr

> 20 kg: 1500ml + 20 ml/kg for each kg > 20
-> maintenance: 60 ml/hr + 1 ml/kg/hr

Calculating fluid deficit (in Liters)
% dehydration x weight (Kg) = #Liters needed

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5
Q

Drugs for acute pain

A

strong pain: Strong opioids (morphine, fentanyl) -> weaker opioids (Morphine)

weak pain: NSAIDs or Tylenol

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6
Q

At what age does a newborn have the PK/PD activity as an adult?

A

age of 1

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7
Q

Which drugs for pain are restricted by the FDA in children?

A

-codeine
-cough medicine
-tramadol

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8
Q

What are the treatment goals for the common cold in children?

A

-Symptomatic relief (congestion and cough)
-Hydration

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9
Q

What are the non-drug therapy options for the common cold?

A

-Vaporizer (cool mist only)
-Warm juice or lemonade
-Honey (in those > 1 year)
-Nasal aspiration

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10
Q

Pharmacotherapy for the common cold

A

-Antihistamines, antitussives, decongestants,
expectorants, and analgesics

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11
Q

Babies of which age should NOT use cough and cold meds?

A

not recommended for babies under 6 years

-lack of data supporting use
-parents overdosing
-ADE: CNS stimulation/depression, lethargy, tachycardia, hallucination, hyperactivity

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12
Q

OTC products to recommend in the common cold

A

-Suctioning of nasal secretions with a bulb syringe
-Saline nose drops or spray
-topical decongestants
-Honey for cough only in kids > 1 year of age (due to infant botulism -> weakness, constipation)
-Tylenol or NSAIDs for pain

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13
Q

Cough in babies is usually NOT treated, when should treatment be considered?

A

-Cough leading to consecutive nights of poor
sleep and/or vomiting
-Cough leading to rib fractures
-Cough severe enough to lead to hypoxia

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14
Q

Treatment for irritant cough

A

-Nasal saline
-Increased humidification
-Honey (older than 1)
-Vapor rub (not in asthmatics bc menthol, and eucalyptus can trigger asthma)
-Antihistamines (for post-nasal drip)
-Albuterol/inhaled corticosteroids
-Dextromethorphan, guaifenesin, benzonatate (>10)

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15
Q

When is a patient considered constipated?

A

<3 bowel movements a week
>1 episode of fecal incontinence
-history of excessive stool retention
-painful bowel movement
-large fecal mass
-large diameter stool blocking the toilet

must meet 2 of these criteria for 1 month or longer

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16
Q

Definition of Encopresis and Soiling

A

Encopresis: Involuntary or voluntary passage of stool at regular intervals

Soiling: Involuntary passage of stool

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17
Q

Which diseases can cause constipation in children?

A

-Hirschprungs disease (segment of the colon without peristalsis)
-high Ca+
-low thyroid
-cows milk allergy
-anatomic (perianal fistula)
-CF (cystic fibrosis)

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18
Q

Which drugs cause constipation?

A

Opiates, Phenobarbital, Antacids

19
Q

What helps for constipation in children?

A

-Toilet training methods
-behavioral

Drugs:
Miralax: 17 g PO Q1H while awake for “cleanouts”
Golytely if severe

OTC: senna, sorbitol, bisacodyl, docusate, rectal suppositroies, enemas

20
Q

What temperature is considered a fever?

A

-rectal temperature: >100.4° F (38°C)
-Ear temperature: >100.4° F (rectal mode), >99.5°F (37.5°C) in oral mode
-Oral temperature: >99.5°F (37.5°C)
-Temporal artery: >100.4° F (38°C)

21
Q

Which temperatures are considered core temperature?

A

Rectal, ear, temporal artery -> if over 100°F it is fever

rectal is more accurate

22
Q

What is the most common cause of fever in children?

A

Infections, UTIs most common

sometimes with vaccines

23
Q

How to use different thermometer

A

rectal:
-apply petroleum jelly on the thermometer
-Gently insert the thermometer into the child’s anus ¼ to ½ inch
-hold for 2 minutes (glass thermometer), or 1 minute (digital)

Oral: don’t use if they had a hot or cold drink, place it under the tongue and close your mouth for 3 minutes (glass thermometer), 1 minute (digital)

Temporal: uses an infrared scanner to measure the temperature of the temporal artery on the forehead (may be better than ear thermometer)

Axillary: place under the armpit for 4-5 minutes

Ear: keep inside the ear for 15 minutes (not reliable for children under 6 months)

24
Q

When should treatment for fever in children be considered?

A

-Underlying medical problem
-History of febrile seizures
-Child is uncomfortable

if the child has a high temperature (>100°F) but looks fine do NOT treat

25
Q

When should a child with a fever be referred to the doctor?
!!!

A

< 3 months: >100°F regardless of how the infant appears

> 3 months: >100°F for more than 3 days or looks ill

3-36 months: >102°F

any age: >104°F or febrile seizure, recurrent fever, chronic medical problem, new skin rash !!!

26
Q

What are the treatment options for fever in children?

A

-Sponging and baths (tepid water 85°F)
-hydration and rest

-Tylenol: 10-15
-Ibuprofen

27
Q

What is the recommended dose of Tylenol and Ibuprofen for fever in children?

A

Tylenol: 10-15 mg/kg/dose Q4-6 hours PRN

Ibuprofen: 5-10 mg/kg/dose

do not need exceed 5 doses a day

28
Q

What is GER vs GERD?

A

GER: the passage of gastric contents into the
esophagus

GERD: symptoms related to GER

tips:
-keep baby upright
-avoid overfeeding
-let them burp
-put baby to sleep on their back (risk of sudden infant death)
-experiment with the diet

29
Q

Symptoms of GERD in children

A

-failure to thrive (rate of weight gain is low)
-vomiting, refusal to eat

Respiratory:
aspiration pneumonia
URI
asthma
cyanosis
cough

Esophageal:
esophagitis
dysphasia
Chest pain (heartburn)

30
Q

What is the Pathophysiology behind GERD in children?

A

-Transient decrease in LES tone
Overfeeding, high-fat meals

-Increased intra-abdominal pressure
excessive coughing, crying, BMs

-Impaired LES pressure/function: nicotine exposure, ß-agonists

31
Q

How is GERD treated in infants?

A

H2-antagonists (may develop tolerance)
ADE: irritability, somnolence, headache

PPIs (longer duration, NO tolerance) - take 15-30 min before food

Prokinetic agents: not recommended. more side effects
Erythromycin, metoclopramide, baclofen

-Decrease the volume of feedings, thickening the
feeding, frequent burping

32
Q

What are the key characteristics of conjunctivitis (pink eye) in an allergic reaction or bacterial or viral infection?

A

allergic reaction: itchy eyes

Bacterial infection: purulent eyes

viral infection: swollen eyes

33
Q

Signs of Colic in babies

A

PURPLE

Peak pattern
Unexpected timing of episodes
Resistance to soothing
Pain-like look
Long bouts
Evening cluster of symptoms

34
Q

Treatment for Colis in Children

A

Dicyclomine (anticholinergic) - not under 6 months !!

-Simethicone: doesn’t really work
-herbals: Camomile, vervain, licorice, fennel

35
Q

What is Enuresis?

A

bed wetting
-voids 2x a week
-for 3 months
-at least 5 years old

36
Q

Treatment for Enuresis

A

Non-pharm is more effective than pharmacologic treatment

-Decreasing fluid for several hours before bedtime
-Voiding before going to bed and when parents to
go bed
-Enuresis alarm

Pharmacologic:
Desmopressin (DDAVP): enhances water reabsorption
Oxybutynin (anticholinergic)
Imipramine (last line)

37
Q

What are the biggest risk factors for otitis media in children?

A

-age under 2 y
-secondhand smoke

signs:
acute onset, ear effusion (full of fluid), inflammation

38
Q

Which pathogens commonly cause ear infections in children?

A

-Strep pneumoniae
treatment: Amoxicillin (high dose)

-H. flu (ß-lactamase producer)
treatment: Augmentin or cephalosporin

-Moraxella catarrhalis (ß-lactamase producer)
treatment: Augmentin or cephalosporin

also:
Group A Streptococcus
Pseudomonas aeruginosa
MRSA

39
Q

What is the dose of Amoxicillin for otitis media?
!!!

A

80-90 mg/kg/day (BID for less diarrhea)

if the child received plain Amoxicillin within the last 30 days ->
Amoxicillin/clavulanate 80-90 mg/kg/day
amoxicillin and 6.4 mg/kg/day clavulanate

40
Q

What is the recommended dose frequency (BID, TID) of Augmentin based on the ratio between Amoxicillin and Clavulante?

A

Everything higher than 4:1 is dosed BID

if 2:1 or 4:1 -> TID

(14:1 for children < 40 kg)

41
Q

What is the duration of treatment for pharyngitis in children?

A

10 days for all Abx (except Azithromycin)

drugs:
Penicillin, IM benzathine PEN G (X1 dose),
*amoxicillin, clindamycin, 1st gen, azithromycin

42
Q

What are the symptoms that indicate referral of a Newborn to One Month of age?

A

-Fever of more than 100.4° F (rectal)
-Drastic change in eating habits
-Uncontrollable crying that is inconsolable

-Vomiting that continues for > 8-12 hours
-Bowel movements > 8 times per day

-Red umbilicus
-“pink eye”
-White patches on the tongue or inside the mouth
-Fast or developing rash

43
Q

Refer One month to One Year

A

> 100.4° F (rectal) if < 3 months
101° F (rectal) if 3-6 months
104° F (rectal) if > 6 months

-Refusal to eat multiple feedings
-Extreme irritability
-Extreme drowsiness
-vomiting or diarrhea to the point of dehydration (if cannot/will not take oral fluids)
-Fast or developing rash

44
Q

What is the recommended dose of Vancomycin in children and infants?

A

15 mg/kg/dose q6h

(adults: 15-20 mg/kg/dose q12h)
shorter interval of q6h in infants and children

Pediatrics (7 decks)

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